Saturday 22 September 2018 ,
Saturday 22 September 2018 ,
Latest News
  • 44 killed as ferry capsizes in Tanzania
  • BNP slams govt for passing Digital Security Bill
  • Zia Charitable Trust graft trial to continue without Khaleda
  • Bangladesh second most gender equal country in Asia
  • Many AL leaders claim green signal from party chief
  • World ‘won’t rest’ on Rohingya crisis
  • World ‘won’t rest’ on Rohingya crisis
21 May, 2018 00:00 00 AM / LAST MODIFIED: 21 May, 2018 12:12:11 AM

Inflammatory bowel disease

Dr Wrishi Raphael
Inflammatory bowel disease

Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease.

Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. Why it happens is still poorly understood, however several authorities agree that there is a sustained response of the immune system, perhaps to enteric flora in a genetically predisposed

individual. The current hypothesis is that there is a lack of appropriate down-regulation of immune responsiveness.

Genetics:

There is increased risk of both ulcerative colitis and Crohn's disease in relatives of patients with either

disease, especially siblings, especially early onset disease.

The familial risk is greater if proband (a person serving as the starting point for the genetic study of a family) has Crohn's rather than ulcerative colitis.

Certain genetic mutations like CARD15/NOD2 are associated with Crohn’s disease

Chron’s disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae.

Clinical features

The natural history of the disease is unpredictable and it most often presents as recurrent episodes of abdominal cramps, diarrhoea and weight loss. The most common location is ileum and ascending colon.

 Ileitis may present with post-prandial pain, vomiting, mass in right lower abdomen and mimics acute appendicitis. Fistulae, fissures, abscesses are common and extra-intestinal manifestations are more common with colonic involvement. Linear ulcers lead to mucosal islands and "cobblestone" appearance

 With an increased risk of perforation into contiguous viscera (leads to fistulae and abscesses).

Investigations

Colonoscopy with biopsy is the first choice of investigation (less often gastroscopy).CT enterography to visualize small bowel. CRP is elevated in most new cases and is useful to monitor treatment response

bacterial cultures.

Management

Smoking cessation

diet

Fluids only during acute exacerbation

Those with extensive small bowel involvement or extensive resection require electrolyte,

mineral and vitamin supplements

The following drugs are effective in symptom management; loperamide, diphenoxylate, codeine

as they all work by decreasing small bowel motility.

Caution if colitis is severe (risk of precipitating toxic megacolon).

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum.

Clinical features

Chronic disease is most frequently characterized by diarrhea and rectal bleeding but can also have a

bdominal cramps/pain, especially with defecation.

Severity of colonic inflammation correlates with symptoms (stool

volume, amount of blood in stool). Tenesmus, urgency, incontinence may also be present.

Systemic symptoms like fever, anorexia, weight loss, fatigue in severe cases with extra-intestinal manifestations are present with characteristic exacerbations and remissions; 5% of cases are fulminant.

Investigations

Sigmoidoscopy with mucosal biopsy (to exclude self-limited colitis) without bowel prep is often sufficient for diagnosis

Colonoscopy is helpful to determine extent of disease; contraindicated in severe exacerbation

CT colonography (formerly barium enema) if colonoscopy cannot be done; contraindicated in severe disease

Stool culture, microscopy, C. difficile toxin assay is necessary to exclude infection however there is no single confirmatory test.

Management

Mainstays of treatment is corticosteroids, with azathioprine used in steroid-dependent or resistant cases. Changes in diet are of little value in decreasing inflammation but may not alleviate symptoms.n (Reprint)

 

Comments

Most Viewed
Digital Edition
More story
From the Editor

From the Editor

Communication between organs and organ  system is vital. It allows the body to adjust the function of each organ according to the needs of the whole…
What are hormones?

What are hormones?

A hormone is a chemical released by one or more cells that affects cells in other parts of the organism. Only a small amount of hormone is required to…
Hormones 101 - what you really need to know

Hormones 101 - what you really need to know

While a great number of women in our culture develop some kind of sexual reproductive organ dysfunction, most are misled about true sexual and reproductive…
Hormonal imbalance

Hormonal imbalance

Hormones are your body’s chemical messengers. Produced in the endocrine glands, these powerful chemicals travel around your bloodstream telling…
New hormonal link suspected in type 2 diabetes

New hormonal link suspected in type 2 diabetes

Two disorders that often occur together -- type 2 diabetes and high blood pressure -- may have a common link in a hormone called aldosterone, researchers…
Deadly infections in kids: What you should know about sepsis

Deadly infections in kids: What you should know about sepsis

ITALO M. BROWN If you try on shoes barefoot, can you get a life-threatening infection? It turns out that this may have already happened, according to…
Signs of depression

Signs of depression

While only a qualified medical or mental health provider can diagnose depression, there are certain warning signs that can help you identify whether you…
Lack of exercise puts one in four people at risk, WHO says

Lack of exercise puts one in four people at risk, WHO says

Alex Therrien Very little progress has been made in reducing levels of inactivity worldwide, experts have warned. A WHO report estimates that more than…
Cancers 'rising around the world'

Cancers 'rising around the world'

Smitha Mundasad There will be 18.1 million new cases of cancer and 9.6 million people will die with the disease this year worldwide, a report predicts.…
Folic acid won't curb dangerous pregnancy complication

Folic acid won't curb dangerous pregnancy complication

High doses of folic acid do not protect pregnant women against a sometimes deadly complication called preeclampsia, a large trial suggests. The finding…
 FDA approves Jivi

FDA approves Jivi

Bayer receives FDA approval for Jivi (antihemophilic factor (recombinant), PEGylated-aucl) for prophylactic treatment of hemophilia A Bayer announced…

Copyright © All right reserved.

Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Disclaimer & Privacy Policy
....................................................
About Us
....................................................
Contact Us
....................................................
Advertisement
....................................................
Subscription

Powered by : Frog Hosting